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Wednesday, August 18, 2010

Clinically Relevant Reporting.

Over the last while we have seen a number of events occur that are linked to POST-EXAMINATION error. One of them was related to our proficiency testing program (see the sheet on CMPT, and visit http://www.cmpt.ca/).

The sample was send as a urine sample from an elder female resident of a nursing home and was found to contain a pure culture of a viridans Streptococcus species.  The committee deemed this as a good and common example of a urine culture containing bacteria that most likely represents urethral or vaginal flora. 
there was an expectation that the laboratories recognize this and incorporate of a cautionary or interpretive comment an assessable requirement. Further providing susceptiblity tests results was deemed as inappropriate.  In other words, the laboratory was expected guide the interpreation of this urine sample result as a probable non-pathogen.

We have received a number of letters about this, citing the absence of commentary on such notes in commonly available textbooks and guidelines. But I think this is one situation where the books and guidelines are behind clinical reality.

This links to another situation that is developing in another part of Canada, where a pathologist has run into difficulty because of the difficulty in reading an interpreting her reports. 

And this ties to some additional discussion that is occurring to replace the term "normal flora" with "normal biota".
The central theme to all these occurrences is the single most important role that a laboratorian has is to provide useful relevant information.  It  is not enough to bring on new and novel tests and it is not enough to produce a rapid, accurate result. If the recipient of the report can't interpret the result, if the recipient can put the report into any clinical context, then everything else is a total waste of time, and potentially dangerous.
I suspect that Microbiologists and Anatomic Pathologists have more to learn about this than our Chemist and Haematology colleagues. Most of our information is in words (as opposed to numbers), and using un-interpretable terms, or mis-interpretable terms or unintelligible terms (call that jargon) is a clear defect.

So we believe that oversight quality partner bodies (like Proficiency Testing) have an obligation to ensure that laboratories provide information that is used for a clinical context.
So I don’t apologies for the committee’s decision to require clinical laboratories to provide not only accurate information, but also to frame the information in clear language that provides clinically appropriate context.
Proficiency Testing is not just about doing a test, it is about providing relevant and understandable information and that involves the whole of the total testing cycle.
M

PS: more on this topic later.

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